Improved cardiovascular risk profile of patients with type 1 diabetes mellitus and renal failure after simultaneous pancreas-kidney transplantation

Abstract

Introduction: The prognosis of patients with type 1 diabetes mellitus and chronic renal failure improves after simultaneous pancreas-kidney (SPK) transplantation. Good control of glycemia and other cardiovascular risk factors may positively influence prognosis. The objective of this study was to evaluate changes in cardiovascular risk factors after SKP.

Patients and methods: We studied 13 patients (aged 36 +/- 8 years, 7 women) before and 12 months after SPK transplantation. All were treated with thymoglobulin, prednisone, tacrolimus, and mycophenolate mofetil. We compared the following pre- and post-SPK parameters: glycemia, HbA(1)c, total cholesterol, HDL, LDL, triglycerides, systolic (sBP), diastolic blood pressure (dBP), and body mass index (BMI).

Results: Twelve months after SPK transplantation, glycemia, HbA(1)c and triglycerides significantly decreased (P < .001; P < .001, and P < .002, respectively), as did sBP (P < .002) and dBP (P < .001). No changes were found for BMI or total, HDL and LDL cholesterol values. The number of patients requiring antihypertensive therapy fell (13 versus 3; P < .002), as did the number of drugs (2.3 +/- 0.8 versus 0.4 +/- 0.7; P < .001). The number of patients requiring statins also fell (11 versus 3; P < .002). At 12 months, all patients had normal renal function (creatinine clearance 85 +/- 10 mL/min) and required no insulin; four had microalbuminuria.

Conclusion: These interim results show an improved cardiovascular risk profile 12 months after SPK transplantation, which lays the basis for a more favorable long-term prognosis.